Presentation of the pro position for focal therapy
Focal therapy for prostate cancer is controversial. It is believed that prostate cancer occurs in more than one area within the prostate at the time of diagnosis. Focal therapy is designed however to treat a very precise area within a gland.
An example of focal therapy that clearly has been established as a prime treatment is that of renal cancer and techniques such as partial nephrectomy which is removal of a portion of the organ and small cancer within the kidney can be destroyed by using a freezing technique known as cryo ablation.
Dr. Mark Emberton and his colleagues at University College London are the world leaders in applying the principles of focal therapy for the cure of prostate cancer. There is a concept in defining prostate cancer that is referred to as an index lesion. This is the largest deposit of cancer in the prostate and is usually greater than 5 mm in diameter. This size lesion can be diagnosed by an imaging study known as the 3Tmri.
Using the information provided by the MRI, the technique of targeted biopsy results in early diagnosis of low volume disease.
It is known that there are prostate cancers that people can live with and they have no significant affects from this. These lesions when studied are low grade, small volume and less than 2 mm in diameter. This type of cancer is frequently found on autopsy and never creates a problem during the patient’s life. The index lesion is the problem and with our ability to identify this and make early diagnosis it is possible to provide curative therapy to many people without removing the prostate gland by using focal treatment. With careful selection of low grade, low volume tumor that make up an index lesion that occupies only one side of the prostate, it can be cured by using a freezing technique known as cryo ablation. This does destroy the part of the prostate that contains the tumor. The opposite side of the prostate does not demonstrate cancer. Therefore this is a method of curative focal therapy. Here are 3 educational videos from our website: Focal Cryotherapy Hemiablation Part 1 , Focal Cryotherapy Hemiablation Part 2 , Focal Cryoablation Minimally Invasive Treatment of Prostate Cancer
There currently are ongoing studies with High Intensity Focused Ultrasound (HIFU). We will discuss this in a forthcoming blog, however there is an educational video, HIFU The Latest Trend for the Management of Prostate Cancer , on our website www.riversideurolgy.com where you can learn much more about this effective treatment.
Our next blog will deal with the other side of this controversy explaining why focal therapy is felt by some experts not to be ready to be considered for treatment of prostate cancer currently.